Etiology, clinical profile, and treatment outcome of peripheral ulcerative keratitis

PURPOSE: To assess the etiology, clinical features, and treatment outcome in patients with peripheral ulcerative keratitis (PUK). METHODS: In this retrospective, observational study, forty-eight eyes of 32 consecutive patients with PUK were included. Demographic profile, etiology, clinical features, treatment history, and outcome were documented. RESULTS: Of the 32 patients, 19 (59%) were male and the mean age at presentation was 54.72 ± 14.92 years. Sixty-eight percent of patients were from rural backgrounds. Half of the patients had bilateral involvement. Fifty percent of patients presented after 4 weeks of the onset of symptoms. Of 48 eyes at presentation, 11 had mild disease, 9 had moderate disease and 28 had severe disease. At presentation, best-corrected visual acuity <3/60 was found in 26 (54%) eyes. Mooren's ulcer (40% eyes) was the most common etiology for PUK. Rheumatoid factor was positive in 8 of 32 patients (25%). Of 32 patients, 19 (59%) required systemic immunosuppression for the control of disease activity. Surgical intervention to maintain anatomical integrity was required in 27 (56%) eyes. No significant change in vision was seen in pretreatment and posttreatment groups. Four eyes failed to heal after 4 weeks of initiation of treatment due to noncompliance of the patient. None of our patients died during follow-up. CONCLUSION: PUK is an indicator of occult systemic autoimmune disease. Mooren's ulcer is the most common cause of PUK. Prompt and adequate immunosuppression is not only eye saving but also lifesaving for patients with PUK of autoimmune origin.